Bridging gaps in the care of people under the age of 60 with complex impairments through cross-indication home-based rehabilitation: a cross-sectional survey with experts in Germany.

BACKGROUND: In Germany, medical rehabilitation services are generally well developed. However, first evidence suggests that there are care gaps in the current outpatient and inpatient indication-specific rehabilitation landscape, which may particularly affect people under 60 with complex impairments. Home-based rehabilitation could help to bridge these care gaps by providing access to rehabilitation for this group of patients. Currently, there are only a few such services for patients under 60. In this context, a cross-indication approach for needs-based care could be relevant to ensure adequate treatment of rehabilitation needs in their entirety. A systematic survey of a broad sample of experts in this field of research is still lacking. The aim of this exploratory study was therefore to assess the views of experts on (1) care needs of people under 60 with complex impairments that are insufficiently covered by current rehabilitation services, (2) the need and associated benefits of home-based rehabilitation as well as perceptions regarding a cross-indication approach, and (3) indication and allocation criteria for a cross-indication approach of home-based rehabilitation. METHODS: We performed a cross-sectional online survey between 03/2024 and 05/2024 with experts from six professional fields from across Germany. We report descriptive statistics on experts' assessments of a wide range of aspects of rehabilitation care and exploratively examined whether experts from different professional fields differ in their assessments. RESULTS: A total of n = 136 experts took part in the survey. The majority of them were physicians in private practice. The experts tend to see a high level of unmet care needs in current rehabilitation services. Their positive assessment of home-based rehabilitation in terms of need and benefits, as well as their positive perception of a cross-indication approach, indicate that home-based rehabilitation conceptualised across all indications may help to bridge these care gaps. CONCLUSIONS: From the experts' perspective, there are various care gaps in current rehabilitation services for people under 60 with complex impairments in Germany. As a complementary service, cross-indication home-based rehabilitation may be a promising but still empirically under-evaluated approach to optimise the functioning of this patient group. TRIAL REGISTRATION: German Clinical Trials Register (DRKS): DRKS00029068; Date of registration: 28.06.2022.